C-sections Show the Way to Solve the Problem of Too Much Medicine

Scientific advances have made life better for many patients, while complicating life for many doctors, but this morning’s Anna Marie D’Amico Lecture presenter says that science is now at a place where it can make things simpler for physicians and better for patients through the strategic application of data.

Neel T. Shah, MD, MPP, Beth Israel Deaconess Medical Center, Boston, MA, will use C-sections as an example of “System Complexity and the Challenge of Too Much Medicine” at 9 am today in Hall D as part of the President’s Program. Dr. Shah said that a consequence of working in our modern, complex health care system is the increased opportunity to err. Those errors come from doing too little or too much.

“Over the last couple of decades, we’ve done a great job of creating systems that avoid the problem of too little, but whenever we issue clinical guidelines that are trying to get us to do more stuff, it makes our lives more complicated because there’s more things that we have to think about,” he said. “But we don’t yet have great systems to deal with the problem of too much, and what we need to be doing is developing systems that simplify our lives.”

C-sections illustrate the problem of too much, said Dr. Shah, who worked in public policy before becoming an obstetrician. His experiences and learning to translate between the languages of economists and health care providers convinced him that working to reduce the number of C-sections would offer a good blueprint for improving the entire health care system.

Dr. Shah said that US hospitals do twice as many C-sections as should be done. These unnecessary procedures cost billions of dollars and cause many women needless suffering.

During today’s lecture, Dr. Shah will outline how systemic changes to areas such as the layout of the labor floor can improve care. It’s hard for obstetricians working from case to case to see how the bigger picture impacts their collective efficacy and efficiency.
“You can take the exact same obstetrician and move him or her to a different hospital and that person’s C-section rates will change,” Dr. Shah said. “The individual provider obviously plays a role, but the environment around him or her plays an equally big role. Everybody who’s ever worked on a busy labor floor knows this. Women like to think their care primarily depends on how they’re doing, but the truth is: it also matters how everybody else on the labor floor is doing, and a really busy labor floor is fundamentally different from a quiet one.”